Screening for Iron DeficiencyScreening for Iron Deficiency
Prepared by Maa’n I.Mesmeh,M.D.Prepared by Maa’n I.Mesmeh,M.D.
...
Screening for Iron DeficiencyScreening for Iron Deficiency
DefinitionsDefinitions
EpidemiologyEpidemiology
PathogenesisPat...
Screening for Iron DeficiencyScreening for Iron Deficiency
IntroductionIntroduction ::
why it is an important health probl...
Screening for Iron DeficiencyScreening for Iron Deficiency
AnemiaAnemia ::
DefinitionDefinition
CausesCauses
CategorizingC...
Screening for Iron DeficiencyScreening for Iron Deficiency
EpidemiologyEpidemiology ::
WHO estimates : most of the world’s...
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
7.00%
8.00%
1975 1985
Prevalence
Prevalence
0%
2%
4%
6%
8%
10%
12%
14%
1 year 2 year 12-15 years 16-49 years
Iron Deficiency
Series1
0%
1%
1%
2%
2%
3%
3%
4%
4%
Toddlers Adolescent Females Child bearing Age
Iron Deficiency Anemia
Series1
Screening for Iron DeficiencyScreening for Iron Deficiency
Attributable factors are different in theAttributable factors a...
Screening for Iron DeficiencyScreening for Iron Deficiency
PathogenesisPathogenesis ::
SiteSite
RoleRole
Absorption :Absor...
Screening for Iron DeficiencyScreening for Iron Deficiency
TransportTransport
Source & Storage : developing fetus ,Source ...
Screening for Iron DeficiencyScreening for Iron Deficiency
Clinical AspectsClinical Aspects ::
S&S depends on the degree o...
Screening for Iron DeficiencyScreening for Iron Deficiency
Clinical AspectsClinical Aspects ::
Other S&S :Other S&S :
poor...
Screening for Iron DeficiencyScreening for Iron Deficiency
Making the DiagnosisMaking the Diagnosis ::
DDx narrows once cl...
Screening for Iron DeficiencyScreening for Iron Deficiency
Making the DiagnosisMaking the Diagnosis ::
The gold standard f...
Screening for Iron DeficiencyScreening for Iron Deficiency
Laboratory ParametersLaboratory Parameters ::
1) Hematological ...
Screening for Iron DeficiencyScreening for Iron Deficiency
Screening for Iron DeficiencyScreening for Iron Deficiency
Laboratory ParametersLaboratory Parameters ::
2) Biochemical Ma...
Screening for Iron DeficiencyScreening for Iron Deficiency
Laboratory ParametersLaboratory Parameters ::
2) Biochemical Ma...
Screening for Iron DeficiencyScreening for Iron Deficiency
Screening for Iron DeficiencyScreening for Iron Deficiency
DietDiet ::
The dietary history is suggestiveThe dietary histor...
Screening for Iron DeficiencyScreening for Iron Deficiency
PreventionPrevention ::
PrimaryPrimary
SecondarySecondary
AAP r...
Screening for Iron DeficiencyScreening for Iron Deficiency
Screening for Iron DeficiencyScreening for Iron Deficiency
TreatmentTreatment ::
oral iron saltsoral iron salts
parenteral...
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Screening for Iron Deficiency - Abu Osba Medical

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Screening for Iron Deficiency - Abu Osba Medical

  1. 1. Screening for Iron DeficiencyScreening for Iron Deficiency Prepared by Maa’n I.Mesmeh,M.D.Prepared by Maa’n I.Mesmeh,M.D. Moderated by Dr. Yousef Abu-OsbaModerated by Dr. Yousef Abu-Osba
  2. 2. Screening for Iron DeficiencyScreening for Iron Deficiency DefinitionsDefinitions EpidemiologyEpidemiology PathogenesisPathogenesis Clinical AspectsClinical Aspects Making the DiagnosisMaking the Diagnosis Laboratory ParametersLaboratory Parameters DietDiet PreventionPrevention
  3. 3. Screening for Iron DeficiencyScreening for Iron Deficiency IntroductionIntroduction :: why it is an important health problem ?why it is an important health problem ? Its serious sequelaeIts serious sequelae Its prevalenceIts prevalence Still seen frequentlyStill seen frequently
  4. 4. Screening for Iron DeficiencyScreening for Iron Deficiency AnemiaAnemia :: DefinitionDefinition CausesCauses CategorizingCategorizing IronIron :: DepletionDepletion DeficiencyDeficiency Iron deficiency anemiaIron deficiency anemia
  5. 5. Screening for Iron DeficiencyScreening for Iron Deficiency EpidemiologyEpidemiology :: WHO estimates : most of the world’sWHO estimates : most of the world’s population are iron deficient , one thirdpopulation are iron deficient , one third have anemia .have anemia . High prevalence in the late 1960s led to theHigh prevalence in the late 1960s led to the introduction of preventive programs .introduction of preventive programs . WIC actWIC act Iron deficiency remains common in theIron deficiency remains common in the developed countries & sever cases stilldeveloped countries & sever cases still occur .occur .
  6. 6. 0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 6.00% 7.00% 8.00% 1975 1985 Prevalence Prevalence
  7. 7. 0% 2% 4% 6% 8% 10% 12% 14% 1 year 2 year 12-15 years 16-49 years Iron Deficiency Series1
  8. 8. 0% 1% 1% 2% 2% 3% 3% 4% 4% Toddlers Adolescent Females Child bearing Age Iron Deficiency Anemia Series1
  9. 9. Screening for Iron DeficiencyScreening for Iron Deficiency Attributable factors are different in theAttributable factors are different in the developing countries from developed countries .developing countries from developed countries . Some sectors of the population are moreSome sectors of the population are more susceptible .susceptible . The difference between the infants & toddlers inThe difference between the infants & toddlers in regard to fortification of formula , diet & cow milkregard to fortification of formula , diet & cow milk ingestion .ingestion . The difference between the male & the female .The difference between the male & the female . In the first months of life no role for ironIn the first months of life no role for iron deficiency .deficiency .
  10. 10. Screening for Iron DeficiencyScreening for Iron Deficiency PathogenesisPathogenesis :: SiteSite RoleRole Absorption :Absorption : heme & nonhemeheme & nonheme inhibitors of iron absorptioninhibitors of iron absorption enhanced absorptionenhanced absorption absorbability difference between human milkabsorbability difference between human milk (50%) , cow milk (10%) , fortified formula (5%) .(50%) , cow milk (10%) , fortified formula (5%) .
  11. 11. Screening for Iron DeficiencyScreening for Iron Deficiency TransportTransport Source & Storage : developing fetus ,Source & Storage : developing fetus , depletion of 50% occurs in the first 4depletion of 50% occurs in the first 4 months , depletion of the stores occur atmonths , depletion of the stores occur at 2-3 months in the preterm2-3 months in the preterm Loss occur in GIT , urine & skin .Loss occur in GIT , urine & skin . Daily needs ( o.8 mg/d : 0.6 growth , 0.2 forDaily needs ( o.8 mg/d : 0.6 growth , 0.2 for ongoing lossesongoing losses
  12. 12. Screening for Iron DeficiencyScreening for Iron Deficiency Clinical AspectsClinical Aspects :: S&S depends on the degree of deficiency &S&S depends on the degree of deficiency & on the rate of development of the deficiencyon the rate of development of the deficiency The most frequent sign is pallorThe most frequent sign is pallor 10-15% splenomegally10-15% splenomegally Irritability & anorexia in infants & toddlersIrritability & anorexia in infants & toddlers 45% of sever cases were asymptomatic45% of sever cases were asymptomatic Developmental delay : ? irreversibilityDevelopmental delay : ? irreversibility
  13. 13. Screening for Iron DeficiencyScreening for Iron Deficiency Clinical AspectsClinical Aspects :: Other S&S :Other S&S : poor growth , blue sclerae , koilonychia ,poor growth , blue sclerae , koilonychia , angular stomatitis , increasedangular stomatitis , increased susceptibility to infections , GITsusceptibility to infections , GIT symptoms , increased lead absorption ,symptoms , increased lead absorption , pica & plumbism .pica & plumbism .
  14. 14. Screening for Iron DeficiencyScreening for Iron Deficiency Making the DiagnosisMaking the Diagnosis :: DDx narrows once classified as microcytic :DDx narrows once classified as microcytic : IDAIDA ThalassemiaThalassemia Lead poisoningLead poisoning Chronic diseaseChronic disease Sideroblastic anemiaSideroblastic anemia
  15. 15. Screening for Iron DeficiencyScreening for Iron Deficiency Making the DiagnosisMaking the Diagnosis :: The gold standard for identifying iron deficiency isThe gold standard for identifying iron deficiency is bone marrow biopsy with Prussian bluebone marrow biopsy with Prussian blue staining .staining . Otherwise no single best test to diagnose ironOtherwise no single best test to diagnose iron deficiencydeficiency Hematological & biochemical tests are based onHematological & biochemical tests are based on RBCs features & iron metabolismRBCs features & iron metabolism Biochemical tests detect early iron deficiencyBiochemical tests detect early iron deficiency CHr is a new testCHr is a new test
  16. 16. Screening for Iron DeficiencyScreening for Iron Deficiency Laboratory ParametersLaboratory Parameters :: 1) Hematological Markers:1) Hematological Markers: The changes through the spectrum from normal toThe changes through the spectrum from normal to IDA in :IDA in : * Hgb & MCV are late markers & less specific* Hgb & MCV are late markers & less specific * RDW is highly sensitive but has low specificity* RDW is highly sensitive but has low specificity * Reticulocytes : for assessing response to Rx .* Reticulocytes : for assessing response to Rx . * CHr : is the best predictor of iron deficiency* CHr : is the best predictor of iron deficiency among Hgb , MCV , s.iron , RDW & transferrinamong Hgb , MCV , s.iron , RDW & transferrin saturation .saturation .
  17. 17. Screening for Iron DeficiencyScreening for Iron Deficiency
  18. 18. Screening for Iron DeficiencyScreening for Iron Deficiency Laboratory ParametersLaboratory Parameters :: 2) Biochemical Markers :2) Biochemical Markers : *S.ferritin is the earliest marker of iron deficiency*S.ferritin is the earliest marker of iron deficiency with high specificitywith high specificity *S.iron is not accurate because it is affected by iron*S.iron is not accurate because it is affected by iron absorption , infection , inflammation & diurnalabsorption , infection , inflammation & diurnal variation .variation . *TIBC measures iron-binding sites but affected by*TIBC measures iron-binding sites but affected by malnutrition , inflammation , chromic infection &malnutrition , inflammation , chromic infection & cancer .cancer . *Transferrin saturation (%) = s.iron ÷ TIBC*Transferrin saturation (%) = s.iron ÷ TIBC
  19. 19. Screening for Iron DeficiencyScreening for Iron Deficiency Laboratory ParametersLaboratory Parameters :: 2) Biochemical Markers :2) Biochemical Markers : *TfR by immunoassay . It presents in*TfR by immunoassay . It presents in immature reticulocytes . It is early markerimmature reticulocytes . It is early marker & can differentiate between IDA & chronic& can differentiate between IDA & chronic illnessillness *ZPP/heme is an early marker but not*ZPP/heme is an early marker but not specificspecific
  20. 20. Screening for Iron DeficiencyScreening for Iron Deficiency
  21. 21. Screening for Iron DeficiencyScreening for Iron Deficiency DietDiet :: The dietary history is suggestiveThe dietary history is suggestive IDA in one study defined as :IDA in one study defined as : 1) < 5 servings per week1) < 5 servings per week 2) > 16 oz milk per day2) > 16 oz milk per day 3) Daily fatty snacks , sweets & > 16 oz soda.3) Daily fatty snacks , sweets & > 16 oz soda. In this case the history was 71% sensitive , 79%In this case the history was 71% sensitive , 79% specific , 97% negative predictive valuespecific , 97% negative predictive value
  22. 22. Screening for Iron DeficiencyScreening for Iron Deficiency PreventionPrevention :: PrimaryPrimary SecondarySecondary AAP recommendation : Hgb & Hct onceAAP recommendation : Hgb & Hct once between 9-12 months & again after 6between 9-12 months & again after 6 months ( consider risk factor & prevalencemonths ( consider risk factor & prevalence in the population ) also all adolscencein the population ) also all adolscence once between 11-21 years in addition toonce between 11-21 years in addition to all mensruating females annuallyall mensruating females annually
  23. 23. Screening for Iron DeficiencyScreening for Iron Deficiency
  24. 24. Screening for Iron DeficiencyScreening for Iron Deficiency TreatmentTreatment :: oral iron saltsoral iron salts parenteral ironparenteral iron PRBCsPRBCs Follow upFollow up : increase of 10 g /L after one: increase of 10 g /L after one month of Rx confirms the diagnosismonth of Rx confirms the diagnosis
  25. 25. THANK YOUTHANK YOU
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